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Med Yr2 > Skin and integument > Flashcards

Skin and integument Flashcards

1
Q

Skin microstructure: Epidermis
- Structure
- Layers

A
  • Stratified squamous epithelium containing keratinocytes and melanocytes
  • 4 to 5 layers
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2
Q

Skin microstructure: Dermis
- Structure (3)

A
  • Connective tissue matrix of collagen and elastin
  • Contains a large network of blood vessels, nerve endings and lymphatics
  • Also contains immune cells (e.g. macrophages)
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3
Q

Skin microstructure: dermis
- Layers (2)

A
  • Papillary layer: interdigitates with epidermis
  • Reticular layer: contains sweat / sebaceous glands and hair follicles
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4
Q

Subcutaneous layer (hypodermis):
- Structure
- Roles

A
  • Areolar connective tissue and adipose
  • Acts as energy store, shock absorption, insulator and allows movement
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5
Q

Scalp:
- Structure
- Amount of layers

A
  • Skin (thin) and subcutaneous tissue overlying the skull (neurocranium)
  • 5 layers
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6
Q

Scalp structure:
S.C.A.L.P

A

S-skin
C-connective tissue
A-aponeurotic layer
L-loose connective tissue
P-pericranium

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7
Q

Scalp wounds: can be alarming
P
S
B
A
P

A
  • Profuse bleeding - good vascular supply
  • Swelling - blood can expand the loose connective tissue layers
  • Bruising
  • Aponeurosis appears white (“down to the bone”)
  • Potential for brain injury
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8
Q

Skin ligaments:
- Structure
- Role
- Determines

A
  • Numerous small fibrous bands
  • Attach dermis to underlying deep fascia
  • Length and density determines skin mobility
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9
Q

Rash: definition

A
  • A change of the human skin which affects its colour, appearance, or texture (internal or external)
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10
Q

Rash and colour change:
- Red
- Blue
- Yellow

A
  • Red: blushing, heat distribution, insect bite infection
  • Blue: cyanosis
  • Yellow: jaundice indicative of bilirubin breakdown
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11
Q

The skin as a physical barrier: (2)

A
  • Protects internal organs from wear and tear and damage
  • Prevents transepidermal water loss due to the hydrophobic nature of keratin and lipids
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12
Q

The microbiome barrier: (2)

A
  • A living first response barrier that transmits signals about potential pathogens to the immune system in the skin
  • shapes regulatory immune response and development of tolerance
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13
Q

The immune barrier: epidermis
- K
- L

A
  • Keratinocytes and resident immune cells in epidermis defend against potential pathogens
  • Langerhans cells - antigen presenting cells activate T cells forming adaptive immune responses
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14
Q

The immune barrier: Dermis (6)

A
  • Mast cells
  • macrophages
  • dendritic cells
  • B and T cells
  • NK cells
  • plasma cells
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15
Q

Chemical barrier: Skin pH
- Explanation

A
  • Skin has an acidic pH, maintained by the acidity of sweat and conversion of triglycerides to fatty acids
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16
Q

Chemical barrier: skin pH
- Effect on microbial barrier function (2)

A
  • Acidic pH inhibits pathogen growth including S. aureus
  • An increase in pH from 5.5 to 6.5 decreases the efficacy of antimicrobial peptide dermcidin by 40%
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17
Q

Chemical barrier: skin pH
- effects on transepidermal water loss (2)

A
  • Lipids that control transepidermal water loss are produced by enzymes that require an acidic pH
  • Neutralizing acidic pH decreases physical barrier properties of epidermis
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18
Q

Vitamin D: effects on skin (6)
- D&P
- A-M E
- S
- P
- A
- H

A
  • Differentiation and proliferation
  • Anti-microbial effects
  • Sebaceous gland regulation
  • Photo-protection
  • Adaptive immunity
  • Hair follicle cycling
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19
Q

Rapidly adapting receptors:
- Role
- Examples (3)

A
  • Detect vibrations, providing timing information over stimulus intensity
    1. Pacinian corpuscles
    2. Meissner’s corpuscles
    3. Hair follicle afferents
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20
Q

Receptive field sizes of different receptor types:
- Superficial receptors
- Deep receptors

A
  • Superficial receptors: small receptive fields and sense fine details and textures
  • Deep receptors: larger receptive field sizes
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21
Q

Receptor types:
- Rapidly adapting
- Slowly adapting

A
  • RA: an initial response that decays rapidly, good for timing but not intensity
  • SA: prolonged response, good for information on stimulus intensity
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22
Q

Spacial acuity: (2)

A
  • ‘Two point discrimination’, varies across the bodies surface in relation to peripheral innervation density
  • The face and lips have the best spacial acuity as they have the highest density of receptors
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23
Q

Experience dependant plasticity of cortical maps: (2)

A
  • Maps are not fixed but change with sensory experience or peripheral damage
  • This plasticity allows a degree of functional recovery from intracerebrovascular accidents (e.g. stroke)
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24
Q

Disorders of tactile sensation: Paresthesia

A
  • Burning or prickling sensation, often accompanied by numbness, usually painless and felt in the hands and feet
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25
Q

Paresthesia: transient causes (4)

A
  • pressure-induced, hyperventilation, viral infection, reactive hyperaemia
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26
Q

Paresthesia: chronic causes (5)

A
  • Vascular disorders, metabolic disorders (diabetes), malnutrition, neuropathy, arthritis
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27
Q

Disorders of tactile sensation: tactile hyperesthesia
- Definition
- Example

A
  • Increased tactile sensitivity due to peripheral neurological disorders, but may have central basis, such as sensory defensiveness in ASD
  • e.g. herpes zoster virus, peripheral neuropathy
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28
Q

Disorders of tactile sensation: tactile hypoesthesia
- Definition
- Example (3)

A
  • Numbness, reduced tactile sensitivity, predominantly due to damage of afferent nerves
  • e.g. ischemia due to vascular disorders, decompression sickness, thiamine deficiency
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29
Q

Cutaneous pain sensation:

A
  • Free nerve endings in skin mediate pain sensation and their properties depend on the channels they express
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30
Q

Pain receptor types (3)

A
  • Polymodal nociceptors
  • Mechano-cold nociceptors
  • Mechanically insensitive nociceptors
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31
Q
  • Polymodal nociceptors:
A

mechanical, thermal and chemical stimuli

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32
Q
  • Mechano-cold nociceptors: mechanical and cold stimuli
A

mechanical and cold stimuli

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33
Q

Mechanically insensitive nociceptors: chemical and thermal stimuli

A

chemical and thermal stimuli

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34
Q

Hyperalgesia:
Allodynia:

A
  • Hyperalgesia: an excessive response to noxious stimuli
  • Allodynia: the production of pain by non-noxious stimulant
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35
Q

Axon reflex to pain stimuli: (3)

A
  • Nociceptor activity causes the release of substance P from axon collaterals
  • This increases blood flow and releases inflammatory agents (histamine) causing redness, swelling and heating
  • Contributes to sensitization of nociceptors and primary hyperalgesia
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36
Q

Primary hyperalgesia (A, B and D) (2)

A
  • Chemically mediated sensitisation of nociceptors results in increased firing rate
  • Sensitising agents include bradykinin, prostaglandins, cytokines
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37
Q

Secondary hyperalgesia (C)

A
  • Occurs without an increase in the firing rate of nociceptors - increased responsiveness of central pain circuits
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38
Q

Allodynia:

A
  • Sensitisation and reorganisation of tactile input to central pain pathways and possibly changes to their descending modulation
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39
Q

Atopic dermatitis (eczema)
- Statistics (3)
- Wider effects

A
  • Affects 1 in 10 people
  • 25% of children
  • 90% develops before the age of 5
  • Huge burden on economy and loss of productivity for patients and caregivers
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40
Q

Acne:

A
  • Affects 85% of 12-24 year olds
  • Most common skin condition in the UK
  • Multiple different types
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41
Q

Psoriasis:

A
  • 2% of the Uk population
  • Multiple different types, associated comorbidities
  • CVS disease, DVT/PE associated
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42
Q

Rosacea:

A
  • 2.5-5% of the population
  • Reddening around the facial area
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43
Q

Skin cancer: ABCDE

A

A - Asymmetry
B - irregular Border
C - Colour alterations
D - Diameter > 6mm
E - Evolving

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44
Q

Atopic eczema and mental health:

A
  • Pruritus severity increased by depression, depression may decrease the itch threshold
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45
Q

Psoriasis and worry:

A
  • 40% of patients associated onset/exacerbation of their psoriasis to “times of worry”
  • 40% exceed pathological worry levels on the PSWQ
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46
Q

Acne causing mental health issues: (4)

A
  • Depression
  • Anxiety
  • OCD
  • Suicidal ideation (5.6%)
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47
Q

Trichotillomania:
- Definition
- Adults vs kids
- Scale

A
  • A condition where people cannot resist an urge to pull out their hair
  • Adults, common psychiatric co-morbidities
  • Children, habit
  • Small areas to total alopecia
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48
Q

Delusional parasitosis:

A
  • Monosymptomatic psychosis
  • Victims acquire a strong delusional belief that they are infested with parasites
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49
Q

Morgellon’s disease

A
  • A woman could see coloured fibres on her sons skin
  • Delusional parasitosis via proxy
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50
Q

Dermatitis Artefacta:

A
  • Intentional, self-inflicted skin disease (self harm)
  • Hard to diagnose, more common in healthcare workers
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51
Q

Body dysmorphic disorders: (3)

A
  • Phobic disorder of body appearance
  • 1-2% of the population
  • Linked to depression, social isolation and 80% experience suicidal ideation
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52
Q

Homeotherms:

A
  • Physiological mechanisms to regulate temperature
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53
Q

Poikilotherms:

A
  • Temperature varies with that of external environment
54
Q

Core and shell body temperatures:

A
  • Core: key areas around vital organs - very little temperature variation
  • Shell: temperature can vary more, as a result of regulatory responses to preserve core temperature
55
Q

Sites for clinical measurement of core temperature:
R
S
A
F
EAM

A
  • Rectal
  • Sublingual
  • Axillary
  • Forehead
  • External auditory meatus
56
Q

Mechanisms of body temperature:
- Heat production
- Heat loss

A
  • Production: metabolism = 100%
  • Loss:
    Evaporation = 20%
    Radiation = 40%
    Convection = 40%
57
Q

Thermoreceptors: characterised by (4)

A
  • Specificity
  • Sensitive to dynamic as well as absolute changes
  • Small receptive fields
  • More cold than warm peripherally
58
Q

Thermoreceptors: central controller (2)

A
  • Set point is generated at the posterior hypothalamus
  • Main transmitters are Ach and prostaglandins
59
Q

Hyperthermia: heat exhaustion
1. Definition
2. Causes

A
  1. Prolonged exposure to raised environmental temperature
  2. Strenuous activity, dehydration, alcohol use, overdressing
60
Q

Hyperthermia: heat exhaustion
3. Symptoms
4. Treatment

A
  1. Faintness, dizziness, fatigue, increased HR, decreased BP, cramps, nausea, headache
  2. Stop activity and rest, move to cooler place, rehydrate
61
Q

Hyperthermia: heat stroke
1. Defintion
2. Risks

A
  1. Definition: Failure to regulate core temperature (40oC or more)
  2. Risks: Can lead to organ damage
  3. Symptoms: Heat exhaustion ++ (racing HR, hot skin, confusion, agitation)
62
Q

Hyperthermia: heat stroke
4. Causes
5. Treatment

A
  1. Can be exertional or environmental
  2. Ice packs / cooling blankets, iv fluids, support injured organs
63
Q

Malignant hyperthermia:

A
  • Aberrant response to Halothane gas
  • Aberrant cellular Ca handling leads to increased muscle metabolic rate, leading to heat generation
  • Must be treated immediately
64
Q

Hyperhidrosis: excessive sweating
- Prevalence
- Location
- Onset

A
  • occurs in 2-3% of people (US)
  • Axillary and/or palmoplantar, sometimes face
  • Adolescence onwards
65
Q

Hyperhidrosis:
- Primary
- Secondary

A
  • Idiopathic
  • hyperthyroidism, some medications, diabetes, obesity
66
Q

Hyperhidrosis treatments: (4)

A
  • Aluminium (chloride hexahydrate) containing antiperspirants (blocks sweat glands)
  • Anticholinergics
  • Botox
  • Surgery
67
Q

Acclimatisation: heat adaptation (4)

A
  1. Lowering of sweat threshold
  2. Shift of threshold for shivering to a lower temperature
  3. Thyroid hormones
  4. Behavioural changes
68
Q

Acclimatisation: cold adaptation (4)

A
  1. Increase in functional insulation ( skin blood flow)
  2. Shift of threshold for shivering to a lower temperature
  3. Thyroid hormones
  4. Behavioural changes
69
Q

Scarring: (2)

A
  • A consequence of wound fibroblasts depositing misaligned and too much cross-linked collagen at the healing wound site
  • Triggered by inflammation at the wound site
70
Q

Identifying skin lesions: flat
- Macule
- Patch

A
  • Macule < 0.5cm
  • Patch > 0.5cm
71
Q

Identifying skin lesions: raised
- Papule
- Nodule
- Plaque

A
  • Papule: raised, solid lesion, <1cm
  • Nodule: Raised, solid lesion, >1cm
  • Plaque: Large, plateau, superficial
72
Q

Seborrhoeic keratosis:

A
  • Highly variable appearance, flat or raised papule or plaque, colour variation
  • Smooth, waxy or warty surface
73
Q

Basal cell carcinoma:
- Structure
- Location
- Prevalence
- Prognosis

A
  • Slow growing lesions, classically a nodule with a central crust
  • Tumour of the basaloid epithelium, commonly caused by sun exposure
  • More common in men, 50% will develop another BCC in 3 years
  • Does not increase mortality, very rarely metastasize
74
Q

Keratin horn:
- Problem
- Solution

A
  • The horn prevents a diagnosis for the underlying lesion
  • 50% benign base, given risk of malignancy it should be referred to secondary care
75
Q

Squamous cell carcinoma:
- Type
- Prognosis
- Risks
- Prevalence

A
  • Keratinocyte tumour
  • Larger lesion = worse prognosis
  • Metastasize locally to lymph nodes
  • More common in elderly males, 50% develop another in 5 years
76
Q

Keratocanthoma:
- Features
- Location
- Timespan
- Treatment

A
  • Rapidly growing volcanic like lesion
  • Can form on sites of trauma, related to hair follicles
  • Resolve spontaneously
  • Not malignant but very similar to SCC, smart to treat it as such until proven otherwise
77
Q

Actinic keratosis:
- Location / prevalence
- Risk
- Options

A
  • Common - often on protruding bits and mens scalps
  • Pre-cancerous, rare to progress to SCC but risk increases with amount
  • Multiple treatment options, prevention is better than cure
78
Q

Sebaceous cyst:
- Type
- Treatment

A
  • Benign lesions
  • Surgical lesions when not inflamed. Make sure the entire sac is removed or will reoccur
79
Q

Lipoma:
- Characteristics (3)

A
  • Benign fatty lumps
  • Mobile under skin
  • Can be painful if traumatised
80
Q

Dermatofibroma:
- Type
- Cause? (2)

A
  • Benign fibrous nodules
  • Probably due to a reactive process
  • If multiple, consider an altered immune state
81
Q

Cherry angiomas: (3)

A
  • Red spots, slightly raised
  • Can be linked to pregnancy and rarely malignant
  • Bleed a lot if punctured
82
Q

Erythema Multiform:
- Appearance
- Causes (2)
- Resolution

A
  • Multiple red spots
  • Commonly caused by HSV infection
  • Less than 10% caused by drugs
  • Spontaneously resolve within 4 weeks, may be recurrent
83
Q

Cellulitis and Erysipelas:
Shared factors
- Common factors

A
  • Unilateral, hot, tender leg, blisters
84
Q

Cellulitis and Erysipelas:
Shared factors
- Risk factors (5)

A
  • Defective barriers
  • Diabetes or immunosuppression
  • Chronic lymphoedema
  • Peripheral vascular disease
  • Previous cellulitis
85
Q

Cellulitis and Erysipelas:
- difference

A
  • Cellulitis: deep
  • Erysipelas: superficial
86
Q

Lipodermatosclerosis:
- Definition
- Symptoms
- Treatment

A
  • Chronic panniculitis (fat inflammation)
  • Acute phase may be painful and red, no systemic upset
  • treated by topical steroid and emollients
87
Q

Paronchyia:
- Causes: acute and chronic
- Acute treatment (3)

A
  • Acute, usually bacterial
  • Chronic, may be fungal
    Acute treatment:
  • Warm soaks
  • Topical antiseptic if localised
  • I + D, dressing, packing
88
Q

Erythroderma: general info (3)

A
  • Generalised, blanchable redness of skin
  • Caused by increased blood flow
  • > 90% of body surface area
89
Q

Erythroderma: Causes
Der
P
D
C or L
I

A
  • Dermatitis 15-40%
  • Psoriasis 8-25%
  • Drugs 10-28%
  • CTCL or leukaemia 15%
  • Idiopathic 30%
90
Q

Erythroderma: signs (5)
P
S
K
N
L

A
  • Pustules
  • Superficial blisters
  • Keratoderma
  • Nail changes
  • Lymphadenopathy
91
Q

Erythroderma: treatment (4)

A
  • Stop all non-essential drugs
  • Emollients
  • Treat underlying infections
  • Fluid balance / temperature control
92
Q

Pyoderma gangrenosum:

A
  • Neutrophilic dermatosis
  • Acutely painful, rapidly growing ulcers
  • 50% caused by underlying systemic disease
93
Q

Necrotising fascitis
- Description
- Prevalence
- Location / effects

A
  • Bacterial infection of soft tissue and fascia
  • 50% occur in young healthy individuals
  • Common on lower leg, severe pain and systemically unwell
94
Q

Steven Johnson Syndrome (SJS):
- Descriptions (2)
- Prognosis

A
  • Life threatening drug reaction
  • Epidermal necrosis
  • High mortality rate
95
Q

Toxic Epidermal Necrolysis (TEN):

A
  • Life threatening drug reaction
  • Skin falls off at literal touch
  • > 60% mortality rate, real bad shit
96
Q

Eczema herpeticum:
- Description
- Cause
- Treatment

A
  • Small, punched out ulcers
  • Herpes simplex type 1 and 2
  • Can become a dermatological emergency, if widespread admit for IV acyclovir
97
Q

Generalised pustular psoriasis:

A
  • Sterile pustules on an erythematous background
  • Stopping steroids, pregnancy, drugs, infection
  • Can be de novo
  • RARE
98
Q

Staphlococcal scalded skin syndrome:
- Description
- Prevalence
- Treatment

A
  • Localised staph infection that releases endotoxins, leads to cleaving of the epidermis
  • More common in children and infants but can occur at any age
  • Monitor for infection and take swabs, good prognosis
99
Q

Sun, vitamin D and skin of colour:
- Skin cancer
- Nitrous oxide

A
  • Less risk of skin cancer but caught later if it occurs
  • Sunlight produces nitrous oxide in the skin, leading to health benefits. More exposure needed for people of colour
100
Q

Mongolian blue spot:
- Description
- Location
- Cause
- Duration

A
  • Lumbosacral dermal melanocytosis
  • May be diffuse or just one patch
  • Caused by the entrapment of melanocytes in the dermis of developing embryos
  • Usually subsides by age 4
101
Q

Ochranosis: (2)

A
  • From hydroquinone deposition in the skin, skin lightening products
  • No treatment, darkens skin
102
Q

Hypopigmentation secondary to corticosteroid injection:

A
  • Often permanent
  • More common in subcutaneous or intradermal injections
103
Q

Vitiligo:

A
  • Acquired depigmentation syndrome
  • Autoimmune condition
  • 1-8% of population, 80% occurs before the age of 30
104
Q

Dermatosis papulosa nigra:
- Type
- Appearance

A
  • Benign
  • Multiple smooth papules on the face and neck
105
Q

Melanonycia: (3)

A
  • Dark lines through the nail bed
  • Benign
  • Look for multiple lines
106
Q

Acral melanoma:

A
  • Common in darker skin, 29-72% of melanomas in skin of colour are acral
  • 1-3% of total melanomas are acral
  • Not related to sun exposure
107
Q

Subungual melanoma: (2)

A
  • Not related to sun exposure, may be trauma related
  • Most common melanoma in the darkest skin types
108
Q

Integument: epidermal derivatives (3)

A
  • Follicular structures (hair)
  • Glandular structures (sebaceous and sweat glands)
    -Keratinous structures (nails)
109
Q

Layers of epidermis surface epithelium: (4)
K
G
P
B

A
  • Keratinised layer
  • Granular cell layer
  • Prickle cell layer
  • Basal (germinal) keratinocyte layer
110
Q

Normal epidermal cell types: non-epithelial (3)

A
  • Melanocytes
  • Langerhan’s (dendritic) cells: type of macrophage
  • Merkel cells: sensory receptors to touch
111
Q

Melanocytes:
- Location
- Role

A
  • Located and attached to basal epidermis
  • Melanin synthesis from tyrosine occurs in melanosomes. It is then transported to kerantinocytes by the melanocyte by endocytosis of dendritic tips
112
Q

Dermis: specialisations (4)
- Superficial
- Deep
- Contains
- Variations

A
  • Superficially contains loosely arranged collagen, elastic fibres, fibroblasts (papillary layer)
  • Deeper layer contains more densely arranged collagen, elastic fibres (reticular layer)
  • Contains small neurovasculature and lymphatics and receptors
  • Thickness varies depending on site (thin on eyelids, thick on soles)
113
Q

Hypodermis:
- Structure
- Roles (3)

A
  • Variable thickness and composition; predominantly composed of areolar connective tissue and loose adipose tissue
  • Insulation, energy storage and shock absorption
114
Q

Sebaceous glands: development

A
  • Develop as an outgrowth of the hair ecternal root sheath
115
Q

Sebaceous glands: holocrine glands

A
  • Secretion (sebum) formed from disintegrated cells and discharges onto hair shaft
  • Sebum is oily and coats the hair and skin surface (moisture and waterproofing)
116
Q

Sebaceous glands: tarsal glands

A
  • Enlarged sebaceous glands which open on the eyelid margin
117
Q

Eccrine sweat glands:
- Location
- Structure
- Secretes??
- Role

A
  • Located all over the body
  • Simple secretory coil in dermis with pore opening on surface via duct
  • Secretes watery, hypotonic fluid, pH 4-6
  • Thermoregulation and lubrication
118
Q

Apocrine sweat glands:
- Structure
- Substance
- Role
- Location

A
  • Straight narrow ducts running parallel to hair follicles
  • Thick secretion into adjacent hair follicle
  • Lubrication and sweat, under hormonal control
  • Found in specific regions (axilla, areola of nipple, groin)
119
Q

Healing by primary intention: (2)

A
  • Wound edges are approximated by sutures, staples or glue
  • Complete return to function, minimal scarring and loss of appendages
120
Q

Healing by secondary intention: (2)

A
  • The wound is left open and required to heal from the bottom up via granulation
  • Wider, more visible scarring
121
Q

Pathogenesis of atopic dermatitis:
1. Abnormal production ….
a)
b)

A
  1. Abnormal production of skin barrier protein such as filaggrin production
    a) Increase transepidermal water loss
    b) Skin dryness and itching
122
Q

Pathogenesis of atopic dermatitis:
2. Abnormalities of …
a)
b)

A
  1. Abnormalities of the immune system
    a) Overproduction of IgE to allergens e.g. foods, mites
    b) Decrease production of antimicrobial protein for killing bacteria
123
Q

Pathogenesis of atopic dermatitis:
3. E
a)
b)

A
  1. Environmental exposures
    a) specific factors e.g. allergens, S aureus
    b) Nonspecific factors: irritants, extreme temperatures, stress, sweating
124
Q

Emollients:

A
  • moisturising treatments applied directly to the skin
  • Hundreds of them available, with varying formularies
125
Q

Emollient types: lotions

A
  • Thin, good for damaged skin and hairy areas. Easy to spread but not very moisturising
126
Q

Emollient types: Creams

A
  • Not very greasy, middle ground moisturising, good for day time use
127
Q

Emollient types: ointments

A
  • Thick, greasy, very moisturising, good for very dry skin and night time use
128
Q

Intertrigo:
- Description
- Cause
- Treatment

A
  • Common inflammatory skin condition
  • Caused by skin on skin friction, intensified by heat/moisture
  • Combination treatment of steroid, antifungal and antibacterial (trimovate). Keep area dry
129
Q

Rosacea:
- Description (2)

A
  • Combination of papules and pustules
  • Ocular involvement is common
130
Q

Rosacea: treatment
- Flushing
- Papules, pustules and nodules

A
  • Vasoconstrictors
  • Metronidazole gel, oral tetracyclines, topical ivermectin
131
Q

Management of plaque psoriasis:
E
M
C & B
L
S

A
  • Emollients
  • Mild topical steroids
  • Calciptriol and bethamethasone
  • Light therapy
  • Systemic agents

Med Yr2 (12 decks)

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